Patient non-compliance complicates remote monitoring

Remote checks of patients' cardiovascular implantable electronic devices can save time and be more convenient for patients, but only if they dutifully participate, Cleveland Clinic researchers say  a study published in HeartRhythm.

They studied 500 remote transmissions from 434 patients with either implantable cardioverter defibrillators, pacemakers or implantable loop recorders. The remote checks took 11 minutes, compared with 27 minutes when done in person.

Transmissions with findings deemed clinically important took longer--21 minutes versus 10 minutes for those with no issues. However, only 8.2 percent of transmission yielded a concern that was forwarded for physician review. The 138 unscheduled transmissions received were more likely to be clinically important.

But nearly half (49.2 percent) the patients missed scheduled transmissions, which surprised the researchers. A mean of 21 patients a day required staff to spend an hour a day tracking them down.

"Once a patient is enrolled in remote monitoring, it does not guarantee their engagement with it," the researchers said. They concluded that rapid processing of transmissions with no issues allowed staff more time to focus on ones of concern, but poor patient compliance complicated the process.

The devices used in the study require manual transmission over a landline. Remote-monitoring systems that require patient interaction tend to have more noncompliance, according to MedPage Today.

An Italian study, as well as several previous ones, found that remote monitoring can be an effective way to keep heart failure patients with implantable defibrillators out of the ER. That research contrasts with work from the Mayo Clinic and Purdue University, however, that found no difference in hospitalization, emergency department visit and hospital day rates for those monitored remotely.

Other efforts have focused on online nurse support for management of chronic conditions.

With growing use of implantable devices, however, the required follow-up time increases as well. And patent engagement is not guaranteed. A recent New England Journal of Medicine article recommends automated "hovering" in patients' daily lives to boost engagement rates. It found diabetic patients who can manage their own disease and heart failure patients were good candidates for this approach.

To learn more:
- read the HeartRhythm abstract
- here's the MedPage Today article

 

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